Category Archives: SafeSupply

much worse

why did the drug supply change so dramatically? why have experts who think in terms of *heroin*, or people whose experience is solely about the market of 5+ years ago been so tragically and completely wrong?

you must understand that synthetic drugs have changed everything.

from Frontline Fentanyl

synthetic drugs are very profitable; we got too poor in a place that was getting wealthier by the day.

the housing prices and overdose deaths correlation.

the Poisoning Massacre is similarly an economic crisis. in fact it is the same one and will not be solved entirely through Safe Supply. it will be mitigated, but the underlying causes will remain. and will return. its more than a housing crisis.

we got too poor. From 2007-2017, basic social assistance in BC was $610/mth and disability was $906/mth. the shelter rate, as ever, was $375/mth.

how does this compare to the supply change in other places? these are from The Future of Fentanyl and Other Synthetic Opioids (2019) from @RANDCorporation and i highly recommend that you check that out.

Fentanyl’s challenge to treatment and harm reduction is etched starkly in Vancouver’s death rate,” the Rand authors state. Accurately. And this is also true:

Imagine, if you can, that twice as many people had died since 2016. That twice as many are dying right now.

Safe Supply is Poverty Reduction. it will eliminate the profit motive, thus the need for the informal market (if you do it right) and for survival crime. we must decommodify drugs. SafeSupply is therefore also Pharmacare.

The illicit market is sufficient proof that we don’t have “universal health care” in canada. While usually people think “two-tier, fancy private health clinics etc” – ie people for whom public health care is not good enough – which we’re not ok with, we also have thousands of people buying drugs of unknown composition on the street, who have no access to the public system which has rejected them. we criminalize them.

We can open the door back to the health care system through the provision of multiple ways to access Safe Supply (please stop saying “low-barrier”; people have different barriers and it doesnt mean they’re “low”). make programs accessible and create choices. NOT models.

an alignment chart for safer supply routes.
lawful good: dispensing machine
lawful neutral: prescribed supply
lawful evil: iOAT/crosstown

neutral good: people's pharmacy/compassion club
true neutral: DIY
neutral evil: "heroin at the corner store"
chaotic good: city-licensed dealers
chaotic neutral: collective self-regulation with drug checking
chaotic evil: i know a guy

and now in the Covidtimes, we know how this is going. Here is my summary of this UNODC report on Covid and the drug supply chain: shit is going to be bad all over. It was published in May, and they were right! There are no bailouts for the informal/illegal economy, but its still part of the global economy, and that whole thing IS NOT GOING GREAT

It is going to get worse and we should acknowledge that. i dont want what happened here to happen everywhere, i wouldnt want this for anyone. and the thing is

We have not really been able to acknowledge what has happened here.

“There is no one to care if you do not care – and that ‘you’, i think, is us, and thats whats happened. If we can’t care – because the work of mere survival becomes too much – then theres nothing that holds us together anymore.

The truth of this unspeakable thought was confirmed for me when people who had moved on came through to visit, people who understood this place deeply five years ago, and said No one cares anymore. Everything is broken, everythings gone, and looked at me in horror.

This feeling – of the world collapsing in on itself, of everyone dying, of inexpressible grief – its been a lot, its a lot to bear and those who remain have only become more isolated, and even more ground down by the work of survival and we’ve slowly lost what we held most dear: our ability to take care of each other. Which is crushing, but true.

We’ve lost so many people. Consider that when you have a social network – a mutual aid network – of people you see and say hey to everyday, share knowledge with, and these are the connections that held everything together – and THREE HUNDRED PEOPLE DIE EVERY YEAR FOR YEARS.

Those connections that we had have been broken, and connection was all we had. We can’t – we couldn’t pretend we were taking care of each other – it was like trying to tread water in a tsunami. we couldn’t. This has been a profound and serious massacre, and we need to acknowledge that. We need to change how we respond, and we have to continue to respond, because this cannot continue like this. “

and i was saying this in the beforetimes.


“it is important to acknowledge that a new era could be coming when synthetic opioids are so cheap and ubiquitous that supply control will become less cost-effective,” the RAND report very accurately states. once again we’re ahead of things in Vancouver. but.

there’s no stopping this with policing – policing makes it worse. and its all too much harm to reduce. we can’t reduce it enough to survive. The treatment system has (for the most part) failed to adjust as well, failed to comprehend the scale of this – there is still a two-week wait to even begin. Here, now: in Vancouver, in December 2020. It is a total failure.

we focus on opioids to our detriment. This is not an opioid crisis.

and this is only the first wave. to users this is obvious.

the past was prologue

our history is your future

its odd that they use the word ‘mixing’ as if the use of benzos like etizolam (which is not licensed for use in canada) was intended.

from Toward the Heart/BCCDC (Dec 23, 2020)

the fact is, these novel benzologues entered this market for the same basic reason that fentanyl did (when it flooded the market, almost entirely replacing heroin, 2015-16): profit.

apparently, its hard to make any money off poor people who are always getting poorer. so we see a very potent non-opioid in a large % of the supply. however, the supply itself changes through time. in fact, it changes in step with the cheque cycle most months. the upshot of this is after (for example) a couple weeks of using down with a high benzo content, your tolerance for opioids is diminished to whatever extent, meaning that you’re going down hard when the supply shifts and contains more fent.

month by month, the supply is inching away from opioids. in Toronto, the % of xylazine, a veterinary tranquilizer, is astonishing. on the west coast, drug checking finds novel benzodiazipines – ie they are custom-made.

in June, I tried to find out what – besides benzos – drug checking was seeing in the down. yes, i said. “active” contaminants and bunk.

  • 4-ANPP
  • acetaminophen
  • ascorbic acid
  • benzocaine
  • cocaine base
  • creatine
  • dextromethorphan
  • dimethyl sultone
  • heroin
  • hci lactose methamphetamine
  • HCI microcrystalline cellulose
  • phenacetin
  • plaster
  • polyethylene glycol
  • propionanilide
  • starch
  • sucrose
  • sugar (uncertain)
  • water
  • xylitol

this is a wrench in safe supply prescribing. you may think you use fentanyl but you also use benzos and a bunch of other random shit. so by shifting to safe supply, you’re withdrawing off all that, which can be terrible, and really dangerous (but not dopesick), and you can be prescribed legit benzos to make it smoother, and you should. whatever you think you use is inaccurate, and whatever a doctor says you use – well, that doctor is wrong.

can someone shift to a prescribed supply when theyve been consuming unknown sludge for however long? i think so, but we have to acknowledge the reality of the sludge to get anywhere. did anyone want all that shit in the first place?

on the other side you have the prescribed opioid without all that other stuff. but to get there i think health systems and prescribers need to get a lot more flexible. you’re not replacing a drug, but a drug market.

and if this is successful, that market will slowly react and there will be a tipping point when enough people are on prescribed supply, and those people will have a lot more money.

i wonder what will happen then

Chaotic Goods

SO what’s the holdup with safe supply? what is this, just for show? for people with money, who already get a safe supply pretty easily? why is it everywhere but [place where you are]?

i dug around, as i like facts, got the same exact number from two sources: as of the end of july, there were 2,181 people accessing safe supply programs in BC. is that a lot? no. how many users in BC? the BCCDC makes a number with a model based on the number of syringes distributed – therefore not counting anyone who smokes anything. so quite an undercount, and the number they had was 55,000+. oh my.

And the supply is getting worse: the number of cases involving “extreme fentanyl concentrations” has doubled since last year. i’ve been comparing this to “the old fent” by comparing that to smooth peanut butter and the concentrations being found as crunchy. hotter than hotspots.

What does this mean? Well, there’s this pandemic that has disrupted everything, and these “extreme” concentrations indicate that while precursors are making it here, the production – in come cases – is not done by the same chemists or with the same equipment. It’s not as well made and there are residual precursors left in the mix, and the undiluted fent concentrations would take down an elephant or two. Yeah safe supply.

if, in march, when the Risk Mitigation guidelines were released, doctors had stepped up and stated publicly, in whatever way, “Yes! if you use drugs, you *are* at risk of fatal OD, i can at least prescribe this, i know its not perfect, lets start somewhere! out in public, let’s go!” and IF, in response, users had said, “FUK YES LETS GO we’ll figure this out” and through the power of *peer pressure* many more doctors got on board, and many more users all over the province did the same, where would we be now?

In other words, we don’t have time to demand perfection. and everyone’s idea of perfect is different. So? Find your own starting point, and work it til its perfect for you.

safe supply alignment chart

i dont understand why everyone is “calling on governments” at the moment. yes its a complicated mess, there should be more funding, but without prescribers… without public support… you are calling on nothing. asking “why don’t they care?” on day 1671 of this emergency is a stupid question to ask. if you don’t know the answer that question yet, you haven’t been paying attention, and don’t want to know the answer. don’t ask “how many have to die?” because the answer is “let’s find out.”

prohibition and death

vancouver and forgetting

alcohol was prohibited in Vancouver during the 1918 pandemic. a lot of people died during prohibition, at the end of the war, in that pandemic

A LOT 

WAVE AFTER WAVE (Epidemic and Public Health : Influenza in Vancouver, 1918-1919 by Margaret W. Andrews)

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health services were already short staffed because many doctors and nurses had gone overseas, to serve in the war.

they couldn’t figure out how people were getting sick − it wasn’t the poor, the old, the weak − they couldn’t figure out how those who became infected were infected. they couldn’t make connections

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the majority of deaths were people between 20-39.

it was prohibition and if you wanted to drink, this was the legal route. you needed a prescription. it was rationed, and mild.

"there were long queues for prescription spirits"

it was pandemic safe supply.

otherwise you had no idea what you were drinking but people went to underground bars anyway. i know this; i was in the basement of old gachet on cordova, where there’s a tunnel to the old bar − people could enter it from down the block & around the corner. to not use alone.

to examine documents now, to be historical, is to wonder at how infrequently the pandemic is mentioned. once it was here.

"there was popular reluctance to admit that normal life was being disrupted"

it was understood very differently in in different places. and death rates tell only only a part of the tale. i wonder what it was by neighbourhood

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table from Margaret W. Andrews, Epidemic and Public Health, BC Studies 1977

if you can’t get social or physical distance, there’s always the historical option. step back, and look at us.

26.9 in 2020 for the whole province
but overdoses

Image

in the aftertimes people tried to forget it happened as quickly as possible and focused on recovering from the war and even called it Great and repealed prohibition and once again believed that everything was fine and nothing would ever change and the pandemic only lasted three years

and almost 800 people had died in the city, which had a population of 100 000

were they supposed to pretend that never happened? to forget that they ran out of flowers for funerals? they sure tried.

will we? did our deaths or lives ever happen?